[254] Fibroepithelial Lesions in the Breast of Adolescent Females: A Clinicopathological Profile of 35 Cases

Dara S Ross, Dilip D Giri, Muzaffar M Akram, Jeff Catalano, Kimberly J Van Zee, Edi Brogi. Memorial Sloan-Kettering Cancer Center, New York

Background: Fibroepithelial lesions (FELs) are the most frequent breast abnormality in females 18 years-old or younger (F≤18). Hormonal changes could impact the diagnosis and clinical course of FELs in this age group. We investigated morphology and clinical behavior of FELs in adolescent females.
Design: We searched the 2000-2011 pathology database for breast FELs in F≤18. FELs in the same age group from a published series (Barrio A, Ann Surg Oncol, 2007) were also included. Two pathologists reviewed all available slides and assessed smooth muscle actin (aSMA) staining (1A4, DAKO) on available lesional tissue. Patient information (INFO) and clinical follow-up (F/U) were obtained from e-medical records.
Results: The study cases are 35 FELs from 30 F≤18; 3 patients (pts) had multiple unilateral FELs, 3 others had bilateral FELs. The median age at diagnosis was 16 y (range 10-18). Race INFO was available for 18 pts: 12 were Caucasian, 4 African-American, and 2 Hispanic. Median age at menarche was 12 y (range 11-14) for 13 pts with available INFO; 12/13 had a FEL at a median of 48 months (mo) (range 0-72) after menarche, 1/13 had a FEL 12 mo prior to menarche. All pts underwent excision; 1 pt subsequently underwent mastectomy. Clinical presentation INFO was available for 26 FELs: 25/26 (96%) were palpable (palp) [22/25 (88%) were also detected on ultrasound (US)]; the non-palp FEL was found at US because of a palp ipsilateral FEL.
The FELs were 20 fibroadenomas (FAs) and 15 phyllodes tumors. Table 1 summarizes morphology and F/U INFO.
Short fascicles admixed with collagen occurred in 100% of juvenile FAs (JFAs). Stromal expansion with pericanalicular pattern typified all 3 variant JFAs. All JFAs, variant included, were strongly aSMA positive.

FEL Characteristics
 NMean Age, Years (range)Gross Size (cm)Mitoses/10 HPFRecurrent CasesMonths to RecurrenceFollow-Up (months)
Fibroadenoma2015.4 (11-18)2.9 (0.7-6)1 (0-7)0-47 (0-326)
Usual516.8 (15-18)2.2 (0.7-3.8)1 (0-2)0-9 (0-17)
Juvenile1215 (11-18)3.1 (1.5-6)2 (0-4)0-61 (0-326)
Juvenile Variant314.7 (11-17)3.3 (2.5-4)3 (0-7)0-58 (0-94)
Phyllodes Tumor1514.9 (10-18)5.8 (1-25)6 (1-20)2Mean 14.545 (0-278)
Benign1115 (10-18)3.3 (1-8.5)3 (1-7)11817 (0-109)
Low Grade115-10111118
Malignant314.7 (13-16)14.5 (4-25)17 (12-20)0-123 (0-278)

Conclusions: Mitoses are common in FELs from F≤18 y, and can be substantial even in FAs. This finding should not be over interpreted in FELs from this age group. Our results provide a useful reference to pathologists and clinicians treating adolescents with FELs.
Category: Breast

Monday, March 19, 2012 8:00 AM

Platform Session: Section B, Monday Morning


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